| NPI | 1548636129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT293667) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 9437389-2401) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2021-06-02 |